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Daily Dose

Antibiotics

1:30 to read

Fall is here and winter is just around the corner, which will usher in another “sick season”. I am already thinking about illness as I just finished reading a JAMA article about the overuse of antibiotics.  Did you know that the CDC estimates that “30% of antibiotic prescriptions in the U.S. are unnecessary”? 

The CDC reported that the majority of these misused antibiotics were prescribed for viral upper respiratory infections including the common cold, bronchitis and sinus and ear infections.  Which gets me back to “sick season” and the busy pediatric office.

Parents frequently bring their child in for one of the many viral upper respiratory infections that a child has, especially in the first 5 years of life, and “assume” that they will receive an antibiotic. In fact, I am still amazed that with all of the news about “superbugs” and emerging antibiotic resistance, some parents continue to “push” for a antibiotic because their child has had a fever, cough and runny nose for several days.  

The head of the CDC recently stated, “antibiotics are lifesaving drugs and if we continue down the road of inappropriate use, we will lose the most powerful tool we have to fight life threatening infections”.  In other words, we doctors need to be very judicious when deciding to prescribe an antibiotic and patients need to ask questions as to the necessity for taking an antibiotic.  It seems much too often I hear a parent say to me, “I am sick as well, so I went to the doctor who gave me an antibiotic for my cough and congestion, why aren’t you going to give an antibiotic to my child?”.  They often follow this statement with, “I felt so much better after being on an antibiotic for several days….”, but I actually think many of them felt better as they were getting better on their own and not due to the antibiotic.

In this JAMA article it was noted that “prescribing rates were highest in children age 2 years and younger. (who also get the most viral URI’s in a year) . There were also distinctions in prescribing practices by region of the country with the West having a lower rate of antibiotic prescribing than the South. 

So…looking forward to “sick season” I may be quoting this JAMA article when I once again explain to a parent, or a child….that their fever, cough and cold is due to a virus and that there is not the need for an antibiotic. In fact, a parent might want to boast, “my child has never been on an antibiotic”...which is a good thing. Save the prescription for a time when it is really warranted, and at the same time “pay it forward” by helping to prevent even more antibiotic resistance in this country.

Your Teen

Acetaminophen, No Threat To Child's Liver

2.00 to read

With more than eight million American kids taking the drug every week, acetaminophen is the nation's most popular drug in children. It's toxic to the liver in high doses, and can be fatal if taken in excess. Very rarely, adults may also get liver damage at normal doses, so doctors had worried if the same was true for kids. Concerns about liver injuries in children who take the common painkiller acetaminophen, sold as Tylenol in the U.S. are unfounded, researchers said on Monday. "None of the 32,000 children in this study were reported to have symptoms of obvious liver disease," said Dr. Eric Lavonas of the Rocky Mountain Poison and Drug Center in Denver. "The only hint of harm we found was some lab abnormalities." With more than eight million American kids taking the drug every week, acetaminophen is the nation's most popular drug in children. It's toxic to the liver in high doses, and can be fatal if taken in excess. Very rarely, adults may also get liver damage at normal doses, so doctors had worried if the same was true for kids. "This drug is used so commonly that even a very rare safety concern is a big concern," said Lavonas, whose findings appear in the journal Pediatrics. Some researchers suspect there is a link between long-term use of acetaminophen and the global rise in asthma and allergies, but the evidence is far from clear at this point. For the new report, researchers pooled earlier studies that followed kids who had been given acetaminophen for at least 24 hours. There were no reports of liver injuries leading to symptoms such as stomachache, nausea or vomiting, in the 62 reports they found. Ten kids, or about three in 10,000, had high levels of liver enzymes in their blood, which usually means their livers have been damaged. In most cases, however, those elevations were unrelated to acetaminophen. And even if they were caused by the drug, they don't indicate lasting damage, according to Lavonas. "Acetaminophen is extremely safe for children when given correctly," he said. "Parents should not be afraid to give acetaminophen to their children when they need it, but they should be very careful about giving the right dose." "If you suspect that you have given a child an overdose, call your state's poison center," he added. The Rocky Mountain Poison and Drug Center receives funding from McNeil Consumer Healthcare, the Johnson & Johnson subsidiary that sells Tylenol, but the researchers said the company did not support this study.

Daily Dose

Gassy Baby? No Problem!

1:30 to read

So you are home from the hospital with your newborn baby and suddenly you realize that the babies you see on TV never cry -  but your newborn is not reading the same script.  All babies have some fussy times, and this is especially true of a newborn in the first few months of life.  While a “typical” baby cries for a total of  3-4 hours a day, there are other babies that seem to be more difficult.  

 

Besides praying for an easy baby it seems to be luck of the draw and you don’t get to pick your baby’s temperament. In many of the cases of an “irritable” infant parents point to the fact that their baby acts uncomfortable and will frequently pass gas or draw up their legs or arch their backs as if something “hurts”.   

 

Your newborn’s tummy and intestines are just as “new” as they are and early on it may be more difficult for some babies to digest breast milk or formula.  In this case pediatricians often try to make changes in a breast feeding mother’s diet (taking out dairy), or changing a formula to a lactose free formula to see if that helps a baby to be more comfortable and less fussy. There are also “elemental formulas” that may be tried for extremely fussy babies. Discuss this with your own pediatrician.

 

Little tummies do make a lot of gas (you hear those toots all of the time) and I often recommend a trial of Little Remedies Gas Relief Drops® which contain simethicone (to help break up gas bubbles). These drops are especially made for infants and do not contain any alcohol, preservatives or dyes.  You can try using the gas drops after your baby has been fed as well as at bed time. 

 

Colic is defined as crying that occurs in an infant for at least 3 hours a day, for 3 days a week, for at least 3 weeks.  Colic typically “rears its angry head” after a baby is 3 -4 weeks of age.  For those irritable, colicky babies (I had one and you will know) I also like to try Little Remedies Gripe Water which is made with ginger and fennel, herbs that have been shown to help relax the  smooth muscle of the intestine.  Again, these drops do not contain any alcohol….which is very important. 

 

I also recommend swaddling and a pacifier for “non- nutritive” sucking to help calm a crying baby.  Many babies also like being on their tummies (tummy time is important developmentally as well) when they are fussy, and you can even massage their backs as well. Remember, even if tempted,  NEVER let your baby sleep on their tummy, even if you are in the room!! Backs to sleep only.

 

Babies also seem to like motion to calm them so holding your baby and rocking or swaying may help decrease crying. A walk in the stroller is sometimes another great way to get a fussy baby to settle down. Fresh air is good for both parent and child!

 

Daily Dose

Treating Scabies

There has been an outbreak of scabies recently. Here's how to treat it.I received an email via our iPhone App from a mother whose 6 year old son had scabies and had been treated two times with permethrin cream, but had just had another re-occurrence.  She wondered if there were any other options for treatment.

Scabies is a mite that causes an eczematous skin rash with associated horrible itching. Infestation with the scabies mite is the result of skin to skin contact.  The mite burrows beneath the skin and the feces of the mite causes an allergic hypersensitivity reaction with resulting skin inflammation and itching. It can be fairly miserable when it goes on for awhile. (Once again my own son had it 20 years ago and that was actually one of the first times I had seen the rash of scabies and it took 3 different doctors including an allergist to finally diagnose it! ). It is sometimes easily diagnosed as a child will have a classic rash on their, trunk, arms and legs, and may even has the classic burrow tract of the mite between their toes and fingers. At other times scabies can be a great masquerader and the diagnosis may be made by scraping the skin and looking at it under the microscope where the actual mite or mite parts may be seen. If in doubt it is always a good idea to do a scraping. The time from infestation with the mite to actually symptoms may be as long as 6 weeks. During this time the “index” case in a family harbors the mites and are infectious, but they may not yet be symptomatic with the typical rash of scabies. When you diagnose a child with scabies the most important thing to do is to not only treat the child but treat the entire family unit.  Because the mite has such a long infectious incubation period it is important to treat all family members at the same time.  The standard treatment is with 5% permethrin cream, which is typically applied at night to all body surfaces from neck to toes. (do not bath before putting on the cream as this will help reduce the systemic absorption of the medicine). Make sure to get the cream between the web spaces of the fingers and toes.  The cream is left on over night (remember entire family) and then washed off in the am.  The next day I would wash all of the clothes and sheets in hot water.  If there are clothing that will not tolerate this put them in a platic bag for 72 hours (which is the life span of the mite off of the body). Even after a patient is successfully treated the itching may continue for several more days and may be treated with topical steroid cream (Cortaid over the counter or a prescription steroid cream).  What you will notice is that while the intense itching is diminishing, there are no NEW areas of rash. Most treatment failures seem to be due to not applying the cream with attention to complete coverage,  or to not treating the entire family at the same time. Another medication Lindane (Kwell) has been used to treat scabie,  but has been associated with the potential for neurotoxicity and is rarely prescribed, especially for younger children. There is also an antiparasitic medication, Ivermectin that is currently being studied for the treatment of scabies. That's your daily dose for today.  We'll chat again tomorrow. Send your question to Dr. Sue!

Daily Dose

Cold Season is Here

School starts and colds start almost simultaneously no matter how old your child is.School starts and colds start almost simultaneously. It even amazes me to see kids with their first cold of the season within 15 minutes of starting school, whether it is Mother's Day Out or high school, it affects every age.

The worst part of a having a cold is knowing that it is going to last seven to 10 days, no matter what you do. The old adage of rest, fluids and nasal irrigation is still the mainstay of treatment. Remember that over the counter cough and cold medicines are not recommended for use in children under the age of 2 and really are not very effective in the overall scheme of things. There has been some renewed interest in zinc and reduction of symptoms and decreased duration of colds so stay tuned for more info on that. In the meantime, keep up hand washing and good cough hygiene to try and prevent getting one of the first colds of the season. That's your daily dose, we'll chat tomorrow!

Your Teen

Acne

Teenage acne can be a traumatic experience for your child. It’s a very common condition, one that impacts over an estimated 17 million people. Dr. Robin Carder, chief of pediatric dermatology at Children’s Medical Center Dallas says acne can be due to a number of things. “Their follicles make more skin cells and that, combined with oil in our skin forms plugs. Once skin is plugged, you get a pimple.”

Dr. Carder says oil is stimulated more in skin during puberty which is sometimes why teens seem to be more impacted. Typically boys get more severe acne than girls. Parents can help their child by encouraging them to gently wash their face twice a day. Dr. Carder says to resist the temptation to scrub as that can aggravate the skin. Teens that have more oily skin should use a wash that contains salicylic acid, which will dry the skin out some. Teens with sensitive skin should use something more gentle like Cetaphil or a Neutrogena glycerin bar. She also says that if your child doesn’t see results from an over-the-counter product within three to four months they should see their pediatrician for a more aggressive treatment. Dr. Carder offers her teenage patients one final tip: “Squeezing and picking is probably the worst thing you can do and it’s probably the fastest way to reach scarring. They heal faster if you leave them alone.”

Daily Dose

Homeopathic Medicine

1:30 to read

I am sitting here writing this while “sucking” on a honey-lemon throat lozenge and drinking hot tea…as it is certainly cough and cold season and unfortunately I woke up with a scratchy throat. I am trying to “pray” it away and drink enough tea to drown it out. While I am not sure it will work, drinking hot tea all day will not hurt you!

 

At the same time (multi-tasking) I am also reading an email from a mother with a 4 month old baby, and they are out of town. Her baby now has a fever and runny nose and she sent me a picture of a homeopathic product for “mucus and cold relief” and wonders if it is safe to give to her infant.  The short answer is NO…even though the product says BABY on the label and has a picture of an infant.

 

Although homeopathic medicines were first used in the 18th century and are “probably safe” it is still unclear if they really work. Unfortunately,  there have been adverse events and deaths associated with some products ( see articles on teething tablets). The principle of homeopathy is that “ailments can be cured by taking small amounts of products that, in large amounts, would cause the very symptom you are treating. In other words, “like cures like” as these products contain “natural ingredients” that cause the symptoms that you are trying to treat, but that have been so diluted as to hopefully stimulate your body’s immune system to fight that very symptom. In this case, congestion and runny nose due to a cold.

 

So…I looked at all of the ingredients which included Byronia, Euphrasia, Hepar and Natrum…to name a few. Byronia is used as a laxative for constipation, Euphrasia is supposed to help with inflammation, Hepar is for people who tend to get “cold and therefore cranky and irritable” and Natrum is used for inflammation due to “too much lactic acid”.  This is the short version. The bottle also says contains less than 0.1% alcohol, but it has alcohol! 

 

While the FDA does monitor how homeopathic medications are made, they do not require these companies to show proof that these medications do what they say they do, as they are “natural”.   With that being said, natural does not always mean effective or safe.  Just as over the counter cold and cough medications are not recommended for children under the age of 2, I too would not recommend homeopathic products be given to an infant.

 

Best treatment for a cold and cough in young children?  Use a saline nasal spray followed by nasal suctioning to relieve the nasal congestion and mucus. I would also use a cool mist humidifier in the baby’s room to keep moisture in the air and help thin the mucus ( especially once the heat is on in the house). Make sure the baby is still taking fluids (breast or bottle) but you may also add some electrolyte solution to give your baby extra fluids if you feel as if they are not eating as well.  Lastly, always watch for any respiratory distress or prolonged fever and check in with your pediatrician!

Daily Dose

Confusion Over Cough & Cold Medicines

Why are so many parents confused about cough and cold medicines?The confusion over cough and cold medications continues and I must admit I am a little confused too.

The Consumer Healthcare Products Association announced changes to the labeling of over-the-counter (OTC) cold products to state “do not use in children under 4 years of age”. The FDA monograph still states “do not use in children under 2 years”. The American Academy of Pediatrics recommends not using OTC cough and cold preparations in children under six years. Looking at the little research on these products two things come to mind: 1.  There have been multiple studies done on these products (in adults) that do not show them to be efficacious for treating common cough and cold symptoms. 2.  The research among children using these products show that dosing errors and accidental ingestions are the leading cause of adverse events. This kind of leaves me thinking why use them at all in children? I really have never been much of a cold medicine giver in general, as I personally did not see my patients getting better any faster nor my own children. We continued to use the good old grandmother tested remedies of lots of rest, fresh squeezed orange juice (sometimes in pays to be sick), chicken noodle soup (canned or home made), and a vaporizer or humidifier in their rooms at night. I also know that younger children get more colds than anyone and no matter what you do you have to get through that too. But miraculously, as kids get older they get less colds and seem to tolerate them a little better. So… for this winter in our practice we are not recommending the use of any of these products for kids and trying the gold standards rest, fluids, cool mist humidifier and tincture of time. We’ll see how it goes. That’s your daily dose, we’ll chat again tomorrow. Send your question or comment to Dr. Sue!

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DR SUE'S DAILY DOSE

Lots of discussion about using prebiotics and probiotics in your child's diet. What is the difference between the two?

DR SUE'S DAILY DOSE

Lots of discussion about using prebiotics and probiotics in your child's diet. What is the difference between the two?

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